Koletzko S, Bürgin-Wolff A, Koletzko B, Knapp M, Burger W, Grüneklee D, Herz G, Ruch W, Thon A, Wendel U
Kinderklinik der Universität, Düsseldorf, Federal Republic of Germany.
Eur J Pediatr. 1988 Nov;148(2):113-7. doi: 10.1007/BF00445915.
Screening for coeliac disease (CD) with serum antigliadin antibodies (AGA) was performed in 1032 diabetic children and adolescents. In 8 children CD had been diagnosed before study entry. Of the remaining 1024 children, 33 had an elevated AGA titre in the first serum sample. On follow-up an elevated AGA titre was confirmed in only 17 of 31 patients. Nine of the repeatedly positive patients underwent jejunal biopsy, and CD was diagnosed in two asymptomatic patients; both were positive for IgG- and IgA-AGA. Among 10 AGA-positive patients in whom biopsies could not be performed, only 1 showed IgA-AGA and thus carried a high risk for CD. From our results we estimate a prevalence of CD in Swiss and German diabetic children between 1.1% and 1.3%. False-positive AGA titres occurred significantly more often in patients with diabetes duration of less than 1 year. AGA testing reached a specificity of 99% if performed at least 1 year after the onset of diabetes. Children suffering from both diabetes and CD showed a diabetes manifestation at a significantly younger age than non-coeliac patients, whereas CD tended to be diagnosed at a remarkably late age.
对1032名糖尿病儿童和青少年进行了血清抗麦胶蛋白抗体（AGA）筛查以诊断乳糜泻（CD）。在研究开始前，已有8名儿童被诊断为CD。在其余1024名儿童中，33名儿童的首次血清样本中AGA滴度升高。随访时，31名患者中只有17名患者的AGA滴度仍保持升高。9名多次检测呈阳性的患者接受了空肠活检，两名无症状患者被诊断为CD；二者的IgG-AGA和IgA-AGA均呈阳性。在10名无法进行活检的AGA阳性患者中，只有1名显示IgA-AGA阳性，因此患CD的风险很高。根据我们的研究结果，我们估计瑞士和德国糖尿病儿童中CD的患病率在1.1%至1.3%之间。糖尿病病程小于1年的患者中，AGA滴度假阳性的情况明显更常见。如果在糖尿病发病至少1年后进行AGA检测，其特异性可达99%。患有糖尿病和CD的儿童出现糖尿病症状的年龄明显低于非乳糜泻患者，而CD往往在很晚的年龄才被诊断出来。
